January 22, 2015

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SPECIAL ANNOUNCEMENTS
Summit Call Recap – January 15, 2015
Information from CDC
Announcements

SPECIAL ANNOUNCEMENTS


Registration for the National Adult and Influenza Immunization Summit Face-to-Face, Invitation Only Meeting Now Open!

The 2015 National Adult and Influenza Immunization Summit (NAIIS) will take place on May 12–14, 2015 in Atlanta, Georgia. A basic agenda and registration information are available on the Summit website. (Note: The password needed for registration to this invitation-only meeting has been shared directly with Summit members or may be obtained by contacting LaDora Woods.) After registering for the meeting, please be sure to follow the links to reserve a room using the hotel rooming block. This will allow Summit organizers to track registration with rooming, as well as helping us meet our rooming requirements with the hotel.


Nominations Now Open for 2015 NAIIS Immunization Excellence Awards (Deadline – February 13, 2015)

Give national recognition to those working to improve public health! The National Adult and Influenza Immunization Summit (NAIIS) is soliciting candidates for the 2015 NAIIS Immunization Excellence Awards. The 2015 awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2014. The awards focus on individuals and organizations that exemplify the meaning of the “immunization neighborhood” (collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases). Unless an award criteria is specifically focused on influenza, it is the intent of the Summit to recognize broader adult immunization activities.

A National Winner will be selected for each award category, and where appropriate an Honorable Mention recipient. The winners will be presented with their awards at the NAIIS meeting which is being held on May 12–14, 2015 in Atlanta, GA. The national winner in each category will be invited to present their programs at the meeting.

The six categories of recognition are:

  • Influenza Season Campaign
  • Healthcare Personnel Campaign
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign
  • NEW! Adult Immunization Publication Award

Additional information and the nomination submission form may be found online. (Note: The nomination deadline is February 13, 2015.)


SUMMIT CALL RECAP – JANUARY 15, 2015


Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 53, ending January 3, 2015. A variety of measures indicate influenza activity is continuing to increase in the U.S.

The ILI-Net national data indicated 5.6% of total patient visits were for influenza-like illness (ILI), which is above the national baseline level of 2.0% for this week. Approximately 24.7% of specimens submitted for testing were positive, which is lower than the level of the previous week. Of the deaths reported through the 122 Cities Mortality Reporting System during week 53, 7.3% were attributed to pneumonia and influenza (P&I), below the 6.9% epidemic threshold for the week. Reports indicated there were 20.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

Five new pediatric deaths were reported during the week. All 5 were associated with influenza type A, but no subtyping was performed. A total of 26 pediatric deaths have been reported during the 2014–2015 season.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 53 is:

  • Widespread – 46 states and Guam
  • Regional – 3 states, Puerto Rico, Virgin Islands
  • Local – 1 state and District of Columbia
  • Sporadic –  no states
  • No activity –  no states
  • No report – no states

Since October 1, CDC has antigenically characterized 355 influenza viruses; 10 2009 H1N1 virus, 288 influenza A (H3N2) viruses, and 57 influenza B viruses. All 10 of the 2009 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014–2015 Northern Hemisphere influenza vaccine. Of the 288 influenza A (H3N2) viruses tested, 91 (31.6%) were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. One hundred ninety-seven viruses (68.4%) tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. Both B/Victoria and B/Yamagata-lineage viruses are circulating in the U.S. All 40 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, a component of both the trivalent and quadrivalent vaccines for the Northern Hemisphere. Fifteen (88.2%) of the 17 B/Victoria viruses were characterized as B/Brisbane/60/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine. Two (11.8%) of the B/Victoria lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

None of 546 specimens tested this season have shown resistance to oseltamivir or zanamivir, and none of 444 specimens tested have shown resistance to peramivir.

Summit members discussed the simplest ways to describe this season’s activity, a theme which was picked up by the following speaker, Brendan Flannery.


Seasonal Influenza Vaccine Effectiveness MMWR – Brendan Flannery (CDC)

Brendan provided an overview of an article, Early Estimates of Seasonal Influenza Vaccine Effectiveness – United States, January 2015, which was released today in the electronic version of the MMWR.

Brendan reminded Summit members that CDC released information in early December which highlighted growing concerns about a potentially severe influenza season due to circulation of the drifted H3N2 influenza virus. This led to this week’s release of the seasonal vaccine effectiveness (VE) information, marking the earliest this information has been available during a season. The major points highlighted in the MMWR are confirmation that VE is low and support for the importance of early treatment with antiviral medications, even in the absence of laboratory confirmation of influenza.

Early estimates indicate that the overall VE at preventing laboratory-confirmed influenza virus infections for this season’s vaccine is 23%, which is among the lowest rates seen since influenza VE began being reviewed in 2004. This percentage is based on data collected from clinics in 5 states (Michigan, Pennsylvania, Texas, Washington, and Wisconsin) that participate in the U.S. Influenza Vaccine Effectiveness Network (Flu VE). Among the 2,321 children and adults enrolled in the network, 950 (41%) were positive for influenza. Of these, 916 (96%) were for influenza A, while only 35 (4%) were influenza B. Overall, about half (53%) of the persons in the study had a history of influenza vaccination, though the proportions vaccinated ranged from 46–66% across sites and when compared by age, sex, race/ethnicity, and self-rated health status. The proportion vaccinated was 49% among patients with influenza, compared to 56% among influenza-negative controls.

Most influenza infections were due to A (H3N2) viruses. Data from Flu VE indicated about 2/3 of the H3N2 viruses identified in patients were from the drifted strain, which is similar to the outcomes seen this season through other surveillance systems. At 26%, the age-stratified VE was statistically significant only among persons age 6 months–17 years. VE was 12% for persons 18–49 years and 14% for persons >50 years. However, Brendan noted that, because the numbers in the age-stratified groups were small and the confidence intervals overlapped, the VE differences among age groups should not be stressed.

The 2014–15 season has so far been similar to the moderately severe 2012–13 season, the last season when influenza A (H3N2) viruses predominated. Rates of influenza-associated hospitalization so far this season are similar to 2012–13, with highest rates among persons >65 years. Brendon emphasized that even a small reduction in infections could result in a significant reduction in hospitalizations.

CDC continues to recommend influenza vaccination to provide protection against other circulating virus strains contained in the vaccine, some of which may become more predominant as the season progresses. Additionally, the vaccine may provide limited cross-protection against the drifted strain. CDC also continues to recommend the use of antiviral medications, particularly for persons who are hospitalized or at high risk of developing complications from influenza infection.

LJ asked if CDC will have a sufficient sample size to be able to determine the level of cross-reactivity between the vaccine strains and the drifted strain. Brendon said CDC hopes to do that, though any information learned will arrive too late to be of assistance this season. Because two of the sites in the Flu VE network are enrolling persons who are hospitalized, we also may be able to examine the impact of the vaccine on hospitalizations. However, Brendan cautioned that prevention of hospitalization is more difficult to determine than prevention of mild illness.


Other Items – L.J Tan (IAC)
  • The Partnership for Quality Care (PQC) has released a 30-second inforgraphic to encourage immunization against influenza despite the reports that suggest it is less effective this year.
  • The 2015 National Adult and Influenza Immunization Summit (NAIIS) meeting will take place on May 12–14 in Atlanta, Georgia. (See information above under “Special Announcements.”)
  • Nomination information is now available for the 2015 NAIIS Immunization Excellence Awards. (See information above under “Special Announcements.”)

INFORMATION FROM CDC


CDC/Influenza Division Weekly Influenza Surveillance Report and CDC Key Points

The CDC weekly influenza surveillance report for week 1, 2015 (ending January 10, 2015) and region specific data are now available. During week 1, 8.5% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza (P&I). This percentage was above the epidemic threshold of 7.0% for week 1.

For the 2014–2015 influenza season, CDC/Influenza Division and the National Center for Health Statistics (NCHS) are collaborating on a pilot project to use NCHS mortality surveillance data for the rapid assessment of P&I mortality.

About 35.0% of the 349 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014–2015 Northern Hemisphere influenza vaccine. About 65.0% of the 349 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus.

Nineteen influenza-associated pediatric deaths were reported to CDC during week 1. Eight deaths were associated with an influenza A (H3) virus and occurred during weeks 51, 52, 53, and 1 (weeks ending December 20, December 27, 2014, January 3, and January 10, 2015, respectively). Nine deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 50, 52, 53, and 1 (weeks ending December 13, December 27, 2014, and January 3, and January 10, 2015, respectively). One death was associated with an influenza virus for which the type was not determined and occurred during week 53, and one death was associated with an influenza B virus and occurred during week 1.

A total of 45 influenza-associated deaths have been reported during the 2014–2015 season from New York City [1] and 18 states (Arizona [1], Colorado [2], Florida [2], Georgia [1], Iowa [2], Kansas [2], Kentucky [3], Louisiana [2], Minnesota [4], North Carolina [2], Nevada [1], Ohio [4], Oklahoma [2], South Carolina [1], Tennessee [4], Texas [6], Virginia [3], and Wisconsin [2]). More detail is available on the FluView website.

Between October 1, 2014 and January 10, 2015, 8,199 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 29.9 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (143.3 per 100,000 population), followed by children aged 0–4 years (30.0 per 100,000 population). Among all hospitalizations, 7,934 (96.8%) were associated with influenza A, 200 (2.5%) with influenza B, 21 (0.3%) with influenza A and B co-infection, and 38 (0.4%) had no virus type information. Among those with influenza A subtype information, 2,110 (99.6%) were A(H3N2) virus, seven (0.3%) were A(H1N1)pdm09 and one (0.1%) was A(H1) unspecified. Additional virus characterization is available on FluView.

Nationwide during week 1, 4.4% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.0%. ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat. An Influenza Summary Update of the influenza activity reported by state and territorial epidemiologists, which indicates geographic spread of influenza viruses but does not measure the intensity of influenza activity, is available. This currently reflects data from January 10, 2015. At this time, most states are reporting widespread influenza activity.

The FluView report for week 1 (ending January 10, 2015) and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for January 16, 2015.


CDC Issues Interim Influenza Vaccine Effectiveness Data for Current Season

On January 16, 2015 CDC published estimates that getting a flu vaccine this season reduced a person’s risk of having to go to the doctor because of flu by 23 percent among people of all ages.

Since CDC began conducting annual flu vaccine effectiveness (VE) studies in 2004–2005, overall estimates for each season have ranged from 10 percent to 60 percent effectiveness in preventing medical visits associated with seasonal influenza illness. The MMWR report states this season’s vaccine offers reduced protection, which underscores the need for additional prevention and treatment efforts this season, including the appropriate use of influenza antiviral medications for treatment.

“Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected, regardless of a patient’s vaccination status and without waiting for confirmatory testing,” says Joe Bresee, branch chief in CDC’s Influenza Division. “Health care providers should advise patients at high risk to call promptly if they get symptoms of influenza.”

More information is available in CDC’s press release, Protection from Flu Vaccination Reduced this Season: CDC urges early treatment of severely ill and high-risk patients. CDC also has released key points (January 15, 2015) on this topic.


Updated Key Points on EV-D68 Infections and Disease

The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. The most current CDC talking points on this issue are from January 8, 2015. (Note: These also were included in a previous issue of the Summit Buzz.)


Updated information on Acute Flaccid Myelitis

Up-to-date key points (from January 8, 2015) are available about the investigation of acute flaccid myelitis in children, including the weekly update of CDC-verified neurologic illness cases reported by states that meet the case definition. (Note: These also were included in a previous issue of the Summit Buzz.)


Upcoming and Recent CDC COCA Calls

2014–2015 Influenza Activity and Antiviral Recommendations
The latest FluView report indicates that influenza activity remains high in the United States and is now widespread in 46 states and Guam. It has been recognized for many years that people 65 years and older are at higher risk of serious complications from influenza, and this influenza season the hospitalization rates in this age group are climbing steeply. CDC recommends that all hospitalized and high risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with one of three available influenza antiviral medications, without waiting for confirmatory influenza testing. During this COCA webinar, clinicians learned about 2014–2015 influenza activity, heard a summary of CDC’s current antiviral recommendations, and discussed data that inform the antiviral recommendations.


ANNOUNCEMENTS


Update on Medicaid Payment for Preventive Services

Part of the Affordable Care Act (ACA) was to increase the payments to primary care providers (albeit a limited scope of providers) for the provision of preventive services, including immunizations. This increase also improved payment of administration fees to providers participating in the Vaccines for Children (VFC) program. As many of you know, this provision expired in 2014. While there are some bills in development that have language reinstituting the increase, there is nothing in 2015 now.

An article recently published in the New England Journal of Medicine, Appointment Availability after Increases in Medicaid Payments for Primary Care, provides an analysis of the impact of payment increases on the number of appointments made under Medicaid. It would be wonderful to have similar analyses specific to immunizations.


House GOP to hold Hearing on Flu

The Energy and Commerce Subcommittee on Oversight and Investigations will examine the response to the flu and look at ways to strengthen the vaccine and treatments. The panel will look at the issue in the context of overall U.S. preparedness for pandemics, an issue that has risen on Congress’s health agenda since the reemergence of Ebola last year.

“The flu is a major public health threat, killing thousands and hospitalizing tens of thousands each year,” said Rep. Tim Murphy (R-Pa.), the subpanel’s chairman, in a statement.

“How can we be better prepared? What is the process used for creating, approving, and distributing the seasonal flu vaccine? When did the federal government know that this year’s vaccine would not be a good match? … These are the kinds of questions Americans all across the country are asking.”


Adult Vaccinations Global Campaign Offers New Insight into a Life-Course Approach to Immunization

The International Federation on Ageing has launched a global campaign to better understand the uptake of adult vaccinations and to promote awareness of the importance of vaccinations throughout the life course. Take the survey today and get involved in the Adult Vaccinations Global Campaign.


European Society of Clinical Microbiology and Infectious Diseases holds 3rd Conference on Vaccines

The ESCMID 3rd Conference on Vaccines, Vaccines for Mutual Protection, will be held from 6–8 March 2015 in Lisbon, Portugal.

The abstract submission for young fellows is still open until 25 January 2015. The current program and registration information are available online.

The conference is accredited with 15 CME points by the European Accreditation Council for Continuing Medical Education (EACCME), and provides an opportunity to meet with top experts and participants to discuss the multiple aspects of direct and indirect protective effects of vaccination as well as novel approaches for vaccination in all ages.


Public Health Foundation Offers Discount on Print Flu Materials for Summit Partners

The CDC offers select flu print materials free for order. To filter the search for flu materials, in the Program drop-down box select “Immunizations and Vaccines (Influenza/Flu)”, then press Go.  Order limits apply and usually require 2-4 weeks for delivery.

In an effort to broaden the availability of print materials, the Public Health Foundation (PHF) is partnering with CDC to provide health care professionals with resources to encourage patients to get their annual flu vaccination. Through its Learning Resource Center online store, the PHF is offering bulk copies of select flu materials for purchase. The PHF is offering a 25% discount on all flu materials to Summit Buzz readers through January 31, 2015 using code FLU015. Orders usually require 7 days for delivery.

A complete list of available materials, along with a description of the item, is shown below.

  • Are You at Risk? Poster (pkg of 5) – This full-color poster informs patients and providers about the risks and complications of the flu, and the importance of getting a flu vaccine.
  • Flu Complications Pad (Flu Shot Reminders Pad) (pkg of 10 pads) – This 4” x 6” pad includes 25 sheets and is customizable by physicians, public health personnel, healthcare professionals, pharmacists, and others to recommend the flu vaccine for patients at high risk for flu complications.  This piece helps a provider identify patients with high risk conditions and gives examples of flu-related complications.
  • I Won’t Spread Flu Poster (pkg of 5) – This full-color poster communicates the importance of flu prevention for providers in health care settings.
  • The Flu: A Guide for Parents Brochure – English (pkg of 25) – This full-color, trifold brochure provides parents and caregivers with useful information regarding the impact of flu on children, the importance of flu vaccination, and how to care for children with flu illness.

The Flu: A Guide for Parents Brochure – Spanish (pkg of 25) – This Spanish-language, full-color trifold brochure provides parents and caregivers with useful information regarding the impact of flu on children, the importance of flu vaccination, and how to care for children with flu illness.


Adult Vaccine Access Coalition (AVAC) Holding Inaugural Meeting on January 23, 2015

AVAC is a newly forming coalition seeking to raise awareness, improve access, and bring adult immunization rates in line with public health objectives. AVAC aims to be an inclusive partnership of organizations who share the desire to inform and engage policymakers towards common legislative and regulatory solutions that will strengthen and enhance access to adult immunization across the health care system. A great deal of positive collaboration is already happening in the adult immunization space, and AVAC seeks to complement and not duplicate this work, and make the work known to policy makers. With the formation of AVAC, there is an opportunity to build upon these efforts through consistent and sustained advocacy in Washington, DC. By bringing together a diverse group of healthcare providers, pharmacies, vaccine makers, public health organizations, and patient and consumer groups, AVAC hopes to make a positive impact on the adult immunization policy landscape.


Medicines Sans Frontieres (MSF) Releases the Second Edition of The Right Shot Report

MSF’s latest vaccines report, The Right Shot: Bringing Down Barriers to Affordable and Adapted Vaccines, is now available online and on the MSF website.

This is the 2nd edition of MSF’s publication on vaccine affordability and adaptation. The report analyzes available vaccine price data from thirteen countries and three international organizations to determine what factors affect vaccine prices and suggest strategies that could be employed to improve affordability. Nine vaccine-specific Product Cards are included for a more in-depth review of technical information and market dynamics for various vaccines.

Please contact MSF staff listed below for further information:

Judit Rius Sanjuan
U.S. Manager & Legal Policy Adviser, Access Campaign
Medecins Sans Frontieres/ Doctors Without Borders (MSF)
333 7th Avenue, 2nd Floor
New York, NY 10001 USA
Office: +1 212 655 3762
Email: judit.rius@newyork.msf.org

Kate Elder
Vaccines Policy Advisor, Access Campaign
Medecins Sans Frontieres/ Doctors Without Borders (MSF)
333 7th Avenue, 2nd floor
New York, NY 10001
Tel: +1 212 763 5737
Email: kate.elder@msf.org


Measles Outbreak Growing – and Immunized Adults Are at Risk

The measles outbreak is growing with 59 confirmed cases in California—18 more than last week—and 42 of those are people who were exposed at Disneyland in December, California health officials said January 21, 2015.

The numbers also reveal an alarming trend: Among those known cases, five people had received two or more measles vaccinations and one person had received at least one dose of vaccine. At least 32 of those infected people are aged 20 or older, accounting for 63 percent of the outbreak, health officials said.


All Healthcare Providers Should Be Immunized, ACP Urges

A newly approved policy recommendation by the American College of Physicians (ACP) urges all healthcare providers to be immunized against influenza; diphtheria; hepatitis b; measles, mumps, and rubella; pertussis; and varicella in accordance with the Advisory Committee on Immunization Practice (ACIP) Adult Immunization Schedule, unless exempt for medical or religious reasons.


Flu Vaccine Shortage Delays Australian 2015 Immunization Program

The start of the seasonal flu vaccination program in Australia is being delayed this year because of manufacturing problems with the reformulated influenza vaccine. Summit Buzz readers will recall that the southern hemisphere vaccine was reformulated to contain the drifted H3N2 strain.


Every Child By Two (ECBT) Compiles Media Information on Its Website

On a daily basis, ECBT assembles significant news media coverage on immunizations in their “Daily Clips.” Summit partners may find this effort useful.


Summit Website Offers Wonderful Resources on Influenza Vaccination

Remember to visit the Summit website for the latest on influenza immunization resources. You also can find archived copies of the Summit Buzz there.


Reminder

Summit calls are scheduled every Thursday at 3 pm ET, unless cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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